Aim: There is little evidence documenting the anaesthetic safety or complications by rural generalist anaesthetists (RGAs) compared to FANZCA anaesthetists in the setting of tonsillectomies. However, RGAs have long provided anaesthesia for tonsillectomies in rural communities. This study aims to compare the anaesthetic outcomes between RGAs and anaesthetists with failed intubation as the primary outcome measure, with the hypothesis of non-inferiority between the 2 cohorts. Method: A retrospective review of the patient anaesthetic records was conducted over 4 sites in Western NSW LHD (Bathurst, Cowra, Forbes, Orange). All 4 sites had tonsillectomies done by the Orange Health Service Department of Otolaryngology. Extracted data included demographics, anaesthetists’ qualification (RGA vs FANZCA), Failed intubation, re-intubation, death, ASA grading, laryngeal view grading, prolonged stay, medications used, and other complications. Results: A total of 314 patient records were reviewed, of which 155 had anaesthesia by RGAs and 159 by FANZCA Anaesthetists. In both cohorts, there were no reported failed intubations or deaths. Neither group recorded major morbidities. There were 5 cases by RGAs which required re-intubation (3.23%), whilst 4 were recorded for FANZCA (2.52%). 9 (5.6%) patients were identified as ASA 3 or above in FANZCA cohort, whilst there were none in the RGA cohort. There were 2 (1.3%) reported laryngospasms in RGA group, and 0 in FANZCA. Conclusion: This study highlights that neither RGAs nor anaesthetists had failed intubations for tonsillectomies. The rates of complications from our secondary outcomes were also similar. Whilst more studies in this field are required, these results highlight the general safety of RGAs with little difference to FANZCA anaesthetists. The presence of RGAs are crucial to providing accessible tonsillectomy care in rural and remote areas.